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Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures.

ABSTRACT: Although hemiarthroplasties are an important treatment for femoral neck fractures, the literature does not provide a clear approach for selecting the implant fixation method. Therefore, we performed a systematic search of the medical literature and identified 11 prospective and retrospective studies that compared results between cemented and uncemented femoral implant fixation methods. After independent blind data extraction, we compared variables between cemented and uncemented cohorts using two different meta-analysis models. Pooled data represented 1632 cemented and 981 uncemented hemiarthroplasties (average age of patients, 78.9 and 77.5 years, respectively). The average operating room times and blood loss volumes were 95 minutes and 467 mL, respectively, for the cemented and 80 minutes and 338 mL for the uncemented cohorts. Postoperative mortality rates, overall complications, and pain were similar between the two cohorts. Despite a few potential trends, we found few statistical differences between cemented and uncemented techniques based on reported outcome measurements. In addition, inspection of this literature underscored the lack of and need for consistent and standardized reporting of outcome variables regarding these procedures.

SUBMITTER: Ahn J

PROVIDER: S-EPMC2584290 | biostudies-literature | 2008 Oct

REPOSITORIES: biostudies-literature

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Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures.

Ahn Jaimo J Man Li-Xing LX Park SangDo S Sodl Jeffrey F JF Esterhai John L JL

Clinical orthopaedics and related research 20080724 10

Although hemiarthroplasties are an important treatment for femoral neck fractures, the literature does not provide a clear approach for selecting the implant fixation method. Therefore, we performed a systematic search of the medical literature and identified 11 prospective and retrospective studies that compared results between cemented and uncemented femoral implant fixation methods. After independent blind data extraction, we compared variables between cemented and uncemented cohorts using tw ...[more]

PMID: 18651200

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Project description:BackgroundThe purpose of our study is to assess the methodology of overlapping systematic reviews related to cemented vs uncemented hip hemiarthroplasties for the treatment of femoral neck fractures to find the study with the best evidence. Also, we assess the gaps in methodology and information to help with direction of future studies.MethodsA systematic search was conducted in September 2022 using Pubmed, Embase, and Cochrane Library. Clinical outcome data and characteristics of each study were extracted to see which treatment had better favorability. The outcomes and characteristics extracted from each study includes, first author, search date, publication journal and date, number of studies included, databases, level of evidence, software used, subgroup analyses that were conducted, and heterogeneity with the use of I2 statistics Methodological quality information was extracted from each study using four different methodologic scores (Oxford Levels of Evidence; Assessment of Multiple Systematic Reviews (AMSTAR); Quality of reporting of meta-analyses (QUROM); Oxman and Guyatt. After that, the Jadad decision algorithm was used to identify which studies in our sample contained the best available evidence. Finally, overlap of each systematic review was assessed using Corrected Covered Area (CCA) to look at redundancy and research waste among the systematic reviews published on the topic.ResultsAfter screening, 12 studies were included in our sample. For the Oxford Levels of Evidence, we found that all the studies were Level I evidence. For the QUORUM assessment, we had 1 study with the highest score of 18. Additionally, we did the Oxman and Guyatt assessment, where we found 4 studies with a maximum score of 6. Finally, we did an AMSTAR assessment and found 2 studies with a score of 9. After conducting the methodological scores; the authors determined that Li. L et al 2021 had the highest quality. In addition, it was found that the CCA found among the primary studies in each systematic review calculated to .22. Any CCA above .15 is considered "very high overlap".ConclusionsThe best available evidence suggests that Cemented HAs are better at preventing Prosthesis-related complications. Conversely, the best evidence also suggests that Cemented HA also results in longer operative time and increased intraoperative blood loss. When conducting future systematic reviews related to the topic, we ask that authors restrict conducting another systematic review until new evidence emerges so as not to confuse the clinical decision-making of physicians.

Project description:INTRODUCTION:Hip fracture is a serious injury in adults, especially those aged over 60 years. The most common type of hip fracture (displaced intracapsular) is treated for the majority of patients with a partial hip replacement (hemiarthroplasty). The hemiarthroplasty implant can be fixed to the bone with or without bone cement. Cement is the current recommended technique but recently some risks have been identified, which could potentially be avoided by using uncemented implants. Controversy, therefore, remains about which type of hemiarthroplasty offers patients the best outcomes.This is the protocol for a multicentre randomised controlled trial comparing cemented hemiarthroplasty versus uncemented hemiarthroplasty for patients 60 years and over with a displaced intracapsular hip fracture. METHODS AND ANALYSIS:Multicentre (a minimum of seven UK hospitals), multisurgeon, parallel group, two-arm, superiority, randomised controlled trial. Patients aged 60 years and older with a displaced intracapsular hip fracture treated with hemiarthroplasty surgery are eligible. Participants will be randomly allocated on a 1:1 basis to either a cemented hemiarthroplasty or a modern hydroxyapatite coated uncemented hemiarthroplasty. Otherwise all care will be in accordance with the National Institute for Health and Care Excellence guidance. A minimum of 1128 patients will be recruited to obtain 90% power to detect a 0.075-point difference in the primary endpoint: health-related quality of life (EuroQol 5 dimensions 5 levels) at 4?months postinjury. The treatment effect will be estimated using a two-sided t-test adjusted for age, gender and cognitive impairment based on an intention-to-treat analysis. Secondary outcomes include mortality, complications including revision surgery and cause, mobility status, residential status, health-related quality of life at 1 and 12?months and health resource use. A within-trial economic analysis will be conducted. ETHICS, DISSEMINATION AND FUNDING:Wales Research Ethics Committee 5 approved the feasibility phase on 2 December 2016 (16/WA/0351) and the definitive trial on 22 November 2017 (17/WA/0383). This study is sponsored by the University of Oxford and funded by the National Institute for Health Research, Research for Patient Benefit (PB-PG-0215-36043 and PB-PG-1216-20021). A manuscript for a peer-reviewed journal will be prepared and the results shared with patients via local mechanisms at participating centres. TRIAL REGISTRATION NUMBER:ISRCTN18393176.

Dataset Information

Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures.

Publications

Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures.

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